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Chapter 12 - Fundamentals of Airway Management

Published online by Cambridge University Press:  18 August 2022

Daniel Rodger
Affiliation:
Senior Lecturer in Perioperative Practice, London South Bank University
Kevin Henshaw
Affiliation:
Associate Head of Allied Health Professions, Edge Hill University, Ormskirk
Paul Rawling
Affiliation:
Senior Lecturer in Perioperative Practice, Edge Hill University, Ormskirk
Scott Miller
Affiliation:
Consultant Anaesthetist, St Helens and Knowsley Hospitals NHS Trust
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Summary

This chapter is written for practitioners working within the perioperative environment that require an understanding of how to assess and manage a patient’s airway. An introduction to airway anatomy highlights relevant anatomical landmarks, and a number of techniques that can be employed for both basic and advanced airway management are described. Airway equipment used by the anaesthetic practitioner will vary depending on requirements of the patient and procedure. Therefore, an overview of both standard and specialist airway equipment available, and how this is used to establish and maintain a patent airway, is provided.

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Publisher: Cambridge University Press
Print publication year: 2022

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References

Marieb, E. N. and Hoehn, K.. Human Anatomy and Physiology, 11th ed. Harlow: Pearson, 2017.Google Scholar
Zhou, C., Chung, F., and Wong, D. T. Clinical assessment for the identification of the potentially difficult airway. Perioperative Care and Operating Room Management 2017; 9: 1619.Google Scholar
Mallampati, S. R., Gatt, S. P., Gugino, L. D.., et al A clinical sign to predict difficult tracheal intubation: a prospective study. Canadian Anaesthetists’ Society Journal 1985; 32: 429434.Google Scholar
Samsoon, G. L. T and Young, J. R. B.. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987; 42: 487490.CrossRefGoogle ScholarPubMed
Baker, P. A., Depuydt, A., and Thompson, J. M. P.. Thyromental distance measurement: fingers don’t rule. Anaesthesia 2009; 64: 878882.CrossRefGoogle ScholarPubMed
Patel, B., Khandekar, R., Diwan, R., and Shah, A.. Validation of modified Mallampati test with addition of thyromental distance and sternomental distance to predict difficult endotracheal intubation in adults. Indian Journal of Anaesthesia 2014; 58: 171175.Google Scholar
Seo, S-H, Lee, J-G, Yu, S-B, et al. Predictors of difficult intubation defined by the intubation difficulty scale (IDS): predictive value of 7 airway assessment factors. Korean Journal of Anesthesiology 2012; 63: 491497.Google Scholar
Williams, U. U. and Hagberg, C. A. Preoperative airway assessment and strategies. Trends in Anaesthesia and Critical Care 2018; 19: 2124.CrossRefGoogle Scholar
Berkow, L. C. and Ariyo, P.. Preoperative assessment of the airway. Trends in Anaesthesia and Critical Care 2015; 5: 2835.CrossRefGoogle Scholar
Kim, H-J, Kim, S-H, Min, N-H, and Park, W-K. Determination of the appropriate sizes of oropharyngeal airways in adults – correlation with external facial measurements: a randomised crossover study. European Journal of Anaesthesiology 2016; 33: 936942.Google Scholar
Bush, S. and Ray, D.. Basic airway management. In Burtenshaw, A., Benger, J., and Nolan, J. (eds.), Emergency Anaesthesia, 2nd ed. Cambridge: Cambridge University Press, 2015, pp. 2029.Google Scholar
Grube, P. G., Fan, D., Pothula, V. R., et al. Prevention of aspiration of nasopharyngeal airway. Indian Journal of Anaesthesia 2010; 54: 74.Google Scholar
Roberts, K., Whalley, H., and Bleetman, A.. The nasopharyngeal airway: dispelling myths and establishing the facts. Emergency Medicine Journal 2005; 22: 394396.CrossRefGoogle ScholarPubMed
Bullard, D., Brothers, K., Davis, C., Kingsley, E., and Waters, J.. Contraindications to nasopharyngeal airway insertion. Nursing 2012; 42: 6667.CrossRefGoogle ScholarPubMed
Martin, J. E., Mehta, R., Aarabi, B., et al. Intracranial insertion of a nasopharyngeal airway in a patient with craniofacial trauma. Military Medicine 2004; 169: 496497.CrossRefGoogle Scholar
Jones, J. R.. Laryngeal Mask Airway: an alternative for a difficult airway. Journal of the American Association of Nurse Anesthetists 1995; 63: 444449.Google Scholar
Teleflex Inc. LMA Classic™: the classic laryngeal mask. Available from: www.lmaco.com/sites/default/files/31817-LMA-Classic-A4Data-0214-LORES-fnl.pdf.Google Scholar
Räsänen, J.. The laryngeal mask airway: first class on difficult airways. FINNANEST 2000; 33: 302305.Google Scholar
Pollack, C. V.. The laryngeal mask airway: a comprehensive review for the emergency physician. The Journal of Emergency Medicine 2001; 20: 5366.Google Scholar
Cook, T. M.. Maintenance of the airway during anaesthesia: supraglottic devices. In Calder, I. and Pearce, A. (eds.), Core Topics in Airway Management. Cambridge: Cambridge University Press, 2005, pp. 4356.Google Scholar
Rosenburg, M. B., Phero, J. C., and Becker, D. E.. Essentials of airway management, oxygenation, and ventilation. Part 2. Advanced airway devices: supraglottic airways. Anesthesia Progress 2014; 61: 113118.Google Scholar
Choudhary, N., Kumar, A., Kohli, A., Wadhawan, S., and Bhadoria, P.. i‑gel as an intubation conduit: comparison of three different types of endotracheal tubes. Indian Journal of Anaesthesia 2019; 63: 218224.CrossRefGoogle ScholarPubMed
Intersurgical. i-gel: the supraglottic airway with the non-inflatable cuff. Available from: www.intersurgical.com/info/igel.Google Scholar
Brain, A. I. J., Verghese, C., and Strube, P. J.. The LMA ‘ProSeal’: a laryngeal mask with an oesophageal vent. British Journal of Anaesthesia 2000; 84: 650654.Google Scholar
Verghese, C. and Ramaswamy, B.. LMA Supreme™ – a new single-use LMA™ with gastric access: a report on its clinical efficacy. British Journal of Anaesthesia 2008; 101: 405410.Google Scholar
Bogetz, M. S.. Using the laryngeal mask airway to manage the difficult airway. Anesthesiology Clinics of North America 2002; 20: 863870.CrossRefGoogle ScholarPubMed
Gerstein, N. S., Braude, D. A., Hung, O., Sanders, J. C., and Murphy, M. F.. The Fastrach™ Intubating Laryngeal Mask Airway®: an overview and update. Canadian Journal of Anesthesia 2020; 57: 588601.CrossRefGoogle Scholar
Liu, E. H., Wender, R. and Goldman, A. J.. The LMA CTrach™ in patients with difficult airways. Anesthesiology 2009; 110: 941943.CrossRefGoogle ScholarPubMed
Michell, V. and Patel, A.. Tracheal tubes. In Calder, I. and Pearce, A. (eds.), Core Topics in Airway Management. Cambridge: Cambridge University Press, 2005, pp. 5768.Google Scholar
Cook, T.. Airway management. In Thompson, J., Moppett, I., and Wiles, M. (eds.), Smith and Aitkenhead’s Textbook of Anaesthesia, 7th ed. Edinburgh: Elsevier, 2019, pp. 456506.Google Scholar
Blunt, M. C., Young, P. J., Patil, A., et al. Gel lubrication of the tracheal tube cuff reduces pulmonary aspiration. Anesthesiology 2001; 95: 377381.Google Scholar
Sengupta, P., Sessler, D. I., Maglinger, P., et al. Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure. BMC Anesthesiology 2004; 4. Available from https://bmcanesthesiol.biomedcentral.com/track/pdf/10.1186/1471-2253-4-8.CrossRefGoogle ScholarPubMed
Sultan, P., Carvalho, B., Rose, B. O., and Cregg, R.. Endotracheal tube cuff pressure monitoring: a review of the evidence. Journal of Perioperative Practice 2011; 21: 379386.Google Scholar
Bingham, R. M. and Proctor, L. T.. Airway management. Pediatric Clinics of North America 2008; 55: 873886.Google Scholar
Maronge, L. and Bogod, D.. Complications in obstetric anaesthesia. Anaesthesia 2018; 73: 6166.Google Scholar
Grape, S. and Schoettker, P.. The role of tracheal tube introducers and stylets in current airway management. Journal of Clinical Monitoring and Computing 2017; 31: 531537.CrossRefGoogle ScholarPubMed
Lee, D. H. and Park, S-J. Effects of 10% lidocaine spray on arterial pressure increase due to suspension laryngoscopy and cough during extubation. Korean Journal of Anesthesiology 2011; 60: 422427.Google Scholar
Mahajan, A., Gupta, A. K., Gulati, S., and Gupta, S.. Efficacy of intravenous lignocaine 2% versus oropharyngeal topical 10% Xylocaine spray before induction of anaesthesia in attenuating the pressor response to direct laryngoscopy and endotracheal intubation. JK Science 2019; 21. Available from: www.jkscience.org/archives/volume211/2-Original%20Article.pdf.Google Scholar
Henderson, J.. Tracheal intubation of the adult patient. In Calder, I. and Pearce, A. (eds.), Core Topics in Airway Management. Cambridge: Cambridge University Press, 2005, 6979.CrossRefGoogle Scholar
Sanehi, O.. Confirmation of tracheal intubation. In Calder, I. and Pearce, A. (eds.), Core Topics in Airway Management. Cambridge: Cambridge University Press, 2005, 8185.Google Scholar
Divatia, J. V. and Bhowmick, K.. Complications of endotracheal intubation and other airway management procedures. Indian Journal of Anaesthesia 2005; 49; 308318.Google Scholar
Mishra, S. K., Ashraf, N. C., Balchander, H., and Badhe, A.S. Location of the upper Murphy’s eye in the uncuffed Ring, Adair, and Elwyn tube. Journal of Anaesthesiology Clinical Pharmacology 2012; 28: 528.CrossRefGoogle ScholarPubMed
Chee, W. K.. Orotracheal intubation with a nasal Ring–Adair–Elwyn tube provides an unobstructed view in otolaryngologic procedures. Anesthesiology 1995; 83: 1369.Google Scholar
Boku, A., Hanamoto, H., Hirose, Y., et al. Which nostril should be used for nasotracheal intubation: the right or left? A randomized clinical trial. Journal of Clinical Anesthesia 2014; 26: 390394.Google Scholar
National Patient Safety Agency. Reducing the risk of retained throat packs after surgery, 28 April 2009: supporting information. Available from: www.medis-medical.com/content-files/NPSA-Report-Reducing-Risk-Retained-Throat-Packs-Surgery.pdf.Google Scholar
Gupta, A., Sharma, R., and Gupta, N.. Throat pack: ‘friend or foe’ for anesthesiologist. Journal of Anaesthesiology and Critical Care 2018; 1. Available from: www.imedpub.com/articles/throat-pack-friend-or-foe-pdf.pdf.Google Scholar
Chauhan, V. and Acharya, G.. Nasal intubation: a comprehensive review. Indian Journal of Critical Care Medicine 2016; 20: 662667.Google Scholar
Ross, A. K. and Ball, D. R.. Equipment for airway management. Anaesthesia and Intensive Care Medicine 2009; 10: 471475.CrossRefGoogle Scholar
Jackson, K. and Cook, T.. Equipment for airway management. Anaesthesia and Intensive Care Medicine 2006; 7: 356359.Google Scholar
Haas, C. F., Eakin, R. M., Konkle, M. A., and Blank, R.. Endotracheal tubes: old and new. Respiratory Care 2014; 59: 933955.Google Scholar
Dhar, P. and Malik, A.. Anesthesia for laser surgery in ENT and the various ventilatory techniques. Trends in Anaesthesia and Critical Care 2011; 1: 6066.Google Scholar
Best, C.. Anesthesia for laser surgery of the airway in children. Pediatric Anesthesia 2009; 19: 155165.Google Scholar
Licker, M., Le Guen, M., Diaper, J., Triponez, F., and Karenovics, W.. Isolation of the lung: double-lumen tubes and endobronchial blockers. Trends in Anaesthesia and Critical Care 2014; 4: 4754.Google Scholar
Wilkinson, J. N., Pennefather, S. H., and McCahon, R. A.. Thoracic Anaesthesia. Oxford: Oxford University Press, 2011.Google Scholar
Jackson, G., Soni, N., and Whiten, C.. Practical Procedures in Anaesthesia and Critical Care. Oxford: Oxford University Press, 2011.Google Scholar
Mirzabeigi, E., Johnson, C., and Ternian, A.. One-lung anesthesia update. Seminars in Cardiothoracic and Vascular Anesthesia 2005; 9: 213226.Google Scholar
Wong, J., Lee, J. S. E., Wong, T. G. L., Iqbal, R., and Wong, P.. Fibreoptic intubation in airway management: a review article. Singapore Medical Journal 2019; 60: 110118.CrossRefGoogle ScholarPubMed
Al-Shaikh, B. and Stacey, S.. Essentials of Anaesthetic Equipment, 4th ed. Edinburgh: Churchill Livingstone, 2013.Google Scholar
Paolini, J-B, Donati, F., and Drolet, P.. Review article: video-laryngoscopy – another tool for difficult intubation or a new paradigm in airway management? Canadian Journal of Anesthesia 2013; 60: 184191.Google Scholar

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